Vaccine
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The first influenza pandemic of the 21st century, due to a new strain of A(H1N1) virus, was declared on 11 June 2009 by the Director-General of the World Health Organization. Fortunately, the international community, including influenza vaccine manufacturers, has been increasing its preparedness for such an event, triggered by the need to stem the spread of the highly pathogenic avian influenza A(H5N1) virus over recent years. ⋯ However, two major issues need to be taken into consideration: how long will it take to produce sufficient pandemic vaccine doses to immunize the global population at risk, including poor populations that have no resources to purchase the vaccine; and how will pandemic vaccine production affect availability of trivalent vaccine for the forthcoming 2009-2010 influenza season. To address these questions, WHO carried out a survey in May 2009 among influenza vaccine manufacturers on their planned seasonal and pandemic production with a view to developing recommendations on the distribution and use of pandemic influenza vaccine.
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The Australian Childhood Immunisation Register (ACIR) was established in 1996 as an opt-out register built on the platform of Medicare, the universal national health insurance scheme. Introduction of financial incentives for providers and parents, linked to the ACIR, followed from 1998. ⋯ The ACIR has been important in implementation of a range of measures to improve childhood immunisation coverage in Australia. Linkage of a universal childhood immunisation register to national health insurance schemes has potential applicability in a variety of settings internationally.
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Comparative Study
Observational safety study of febrile convulsion following first dose MMRV vaccination in a managed care setting.
A combined measles, mumps, rubella, varicella live vaccine (MMRV, Merck and Co., Inc., US) was recently licensed in the US. Pre-licensure clinical trial data showed a significant increase in fever in days 5-12 following MMRV vaccination as compared to the vaccines given separately (MMR+V). This post-licensure retrospective cohort study was undertaken to assess the incidence of febrile convulsion following MMRV. ⋯ These data suggest that the risk of febrile convulsion is increased in days 5-12 following vaccination with MMRV as compared to MMR+V given separately during the same visit, when post-vaccination fever and rash are also increased in clinical trials. While there was no evidence of an increase in the overall month following vaccination, the elevated risk during this time period should be communicated and needs to be balanced with the potential benefit of a combined vaccine.
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Epidemic meningitis in Africa remains an important and unresolved public health problem. Bacteriologic and epidemiologic data collected over the past 30 years have consistently established the importance of Group A Neisseria meningitidis as the dominant etiologic agent. The meningococcal Group A capsule is the major virulence factor; it is a polysaccharide comprised of a repeating unit of partly O-acetylated alpha-1,6-linked N-acetylmannosamine phosphate. ⋯ A meningococcal A conjugate vaccine (MenAfriVac) has been developed and tested in Phase II clinical trials in Africa. The vaccine has been shown to be safe and to generate a sustained immunologic response with functional antibody 20 times higher than that seen with polysaccharide vaccine. Widespread use of such a vaccine is likely to generate herd immunity and to put an end to Group A meningococcal epidemics.
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Neisseria meningitidis is an important cause of bacterial meningitis and septicaemia with most disease caused by meningococci bearing serogroups A, B, C, Y and W-135 polysaccharides. Monovalent serogroup C conjugate vaccines have become established in the immunisation programmes in many countries and the first quadrivalent meningococcal vaccine, containing the polysaccharides from 4 of the serogroups A, C, Y and W-135 meningococci conjugated to a protein carrier was licensed in the US in 2005. This vaccine and others in development offer the potential to broaden population protection against meningococcal disease.